Exam 3: Palliative Care Flashcards
Where do most patients want to die?
Where do they actually die?
Want to die at home
Most die in the hospital
EOL hospital stay and association with QoL?
EOL hospital stay associated with lower QoL
Palliative care and hospice effect on QoL?
Increased QoL
EOL hospital stay and effect on caregivers?
Increased PTSD
Increased prolonged grief disorder
Early EOL care conversations leads to three things
- Less aggressive intervention and ICU
- Earlier and more appropriate hospice referral
- No change in survival
Palliative care fills the GAPS
Goals of care
Advance care planning
Psychosocial/spiritual support
Symptom control
Improves QoL regardless of dx
Hospice as compared to palliative
Focused on EOL care
Depends on prognosis (<6 mo to live)
“Will this patient die w/in 1 yr?”
How long does the dying process take?
Hours to days
Sign of imminent death?
Mouth and eyes open
Other: Bedbound Changes in skin color/temp control Loss of bowel sounds (1-2days) Cardio/neuro/respiratory collapse
Anorexia at end of life
Normal - no more body utilization of energy
Fluids may be harmful - pulm edema
Educate family - keep mouth moist
What is mottling?
Skin discoloration due to decreased perfusion
Normal in the dying process
Neurological changes
Decreased LoC Loss of swallow Loss of sphincter Terminal delerium Near-death awareness
Pain control
Opioids
Probably under treated
Use cues/clues
Cheyne-stokes respiration
Increase and decrease of frequency
May see many, various respiratory patterns in actively dying patient
